16 areas your doctor may not check before prescribing medication for anxiety or depression

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“Considering your family history, I think you ought to consider antidepressants,” my doctor stated, her tone gentle yet firm as I sobbed in her office.

My mood had been a battle for as long as I could remember, but lately it had become particularly unbearable. Every morning I awoke to inexplicable heaviness and lethargy – a depression thick with anxiety, guilt, and futility. I’d always felt like a bit of an outsider, but this was extreme. I felt disconnected from reality – like those dreams where you’re trying to scream or fight back or run but are paralyzed. I’d been exhausted for months, taking naps on the yoga mat in my office or the front seat of my car during lunch. I couldn’t concentrate in my sessions with clients and felt like my brain was operating at 20%.

As a mental health therapist, I knew the signs were there: I was depressed.

I hadn’t led with my low mood to my doctor. I’d been experiencing physical symptoms that scared me: my hair was falling out, my body ached, and I hadn’t had a regular period since going off birth control a couple years earlier. Despite my veggie-heavy diet and daily exercise, my blood sugar was pre-diabetic. I knew something was off physically as well as mentally.

My latest blood tests had been in the “normal range,” so my doctor dismissed my symptoms, chalking them up to anxiety. She didn’t ask about my diet, dating or social life. She didn’t ask me about how much coffee I drank or exercise I got, what I do outside of work, or if I have a history of trauma. She saw my tears of desperation, pulled out her prescription pad, and jotted down the latest antidepressant the drug rep had convinced her to champion over catered lunch and veneered smiles.

I left her office, weeping in a haze of frustration, shame, and helplessness. Fortunately, though, I didn’t admit defeat. I’ll spare you the minutia, but I ultimately learned I was living with subclinical hypothyroidism. Within days of treating the condition, my symptoms vanished and joy returned to my life.

I tell this story because the western medical system is way too quick to treat the 43.4 million Americans living with mental illness with medication, which often comes with dangerous side effects. The pharmaceutical industry makes more than $400 billion a year, which allows for more funding to go into research to support the efficacy of the drugs (and less funding for holistic treatments). It’s not that I’m anti-medication; in fact, there are many cases where I recommend my clients explore medication as an adjunct to our work together. However, more often than not, depression is a symptom of something else going on. It’s not meant to be medicated away, it’s meant to be listened to. Just as physical pain of an injury is there to tell us something, the emotional pain of depression is there to tell us something as well.

Here are sixteen things it might be trying to tell you:

1. You’re disconnected socially: It’s now well documented that social isolation leads to depression, and vice versa. Humans are social beings. It’s evolutionary. In caveman days, we wouldn’t survive or procreate if we isolated ourselves. So when we sit behind a computer all day and go home to Netflix, our depression might just be there to tell us we’re lacking support and need to connect. In real life.

2. You’re too hard on yourself: This one’s my specialty, both personally and professionally. I define perfectionism as having five characteristics: unrealistically high expectations, a fear of failure, a critical inner voice, self-worth dependent on outcomes and achievements, and inability to sit with uncomfortable feelings. This constellation creates and perpetuates depression because we essentially become our own abusers, never feel worthy, and judge ourselves for experiencing anything other than happiness and calm.

3. You’re under too much stress: Studies show prolonged stress leads to depression. That much cortisol pumping through your system is going to cause all sorts of physical and emotional maladies, so consider whether you might have too much responsibility on your plate at the moment and not enough coping.

4. You’re grieving or in transition:Grief mimics depression, meaning you’ll experience changes in appetite and sleep, spontaneous crying spells, chronically low mood, and difficulty concentration. And remember that we don’t just experience grief when someone dies; relationship endings (yes, even if you’ve only been dating for a few weeks!), friendship breakups, job loss, miscarriage, illness, pet loss, and more will evoke grief as well.

5. Your body and mind are starved of movement: Some studies show exercise is as effective as a mild antidepressant in treating depression. And its side effects are a lot less debilitating.

6. Your diet needs an overhaul: We’re finally acknowledging there is a strong connection between what we put in our mouths and how we feel emotionally. A diet high in processed foods and with a high omega 6:3 ratio leads to inflammation, which studies are now showing is a precursor to depression. Deficiencies in certain nutrients will also contribute to depression and anxiety, such as magnesium, zinc, omega 3’s, and vitamins B12 and D. Finally, our blood sugar levels and mood are connected. Ensuring you’re getting protein and fat alongside your carbs with prevent the spikes and crashes that make you hangry.

7. You’re putting a substance in your body that’s messing with your brain chemicals: Caffeine, alcohol, nicotine, marijuana – these are not benign substances. These are drugs that throw off your hormones, mess with your sleep, and, most importantly, screw with the neurotransmitters in your brain that stabilize your mood.

8. Your hormones are imbalanced: Hormonal imbalance is epidemic these days. If you don’t get a period or have serious PMS symptoms, it’s likely a sign you have hormonal imbalance or deficiency. Estrogen, progesterone, and cortisol are all correlated with mood.

9. Your gut health is compromised: 90% of our serotonin, the “feel good” chemical, is produced in the gut, meaning gut health is way important for our mental health. Numerous studies support the positive effects of probiotics on mood, whereas leaky gut syndrome is associated with poor mental health.

11. You’re low on self-care: When’s the last time you had fun or did something nice for yourself? We live in a society that emphasizes productivity and selflessness, which leads to burnout and depression. Consider giving yourself permission to play, but keep in mind “playing” while depressed generally won’t evoke the same feelings of joy as playing when not depressed. So try to do it just to do it, not to achieve an outcome or feeling you haven’t experienced in a long time.

12. You’re missing a sense of purpose: A lack of meaning is continually cited as a precursor to depression. In fact, I often explore with my clients whether we ought to listen to their depression as it’s there to tell them they’re not living a life in line with their values and desires.

13. You’re sleep deprived: You know how after a bad sleep the world is just a harder place to exist? Research supports this. Sleep deprivation increases vulnerability to negative mood disturbances.

14. You’re unknowingly ingesting toxins: I’m not getting all hippie on you here. There’s legitimate research to back up the effects of toxins in our food, medication, cleaning products, environment, and so on. Peruse the Environmental Working Group site to learn more where they might be hiding.

15. You’re struggling with a physical condition and depression and anxiety are symptoms:Lyme disease and thyroid disease are just two examples of physical conditions for which depression and anxiety are symptoms. If you’re experiencing depression, make sure you get a full blood panel done and assessed by a functional medicine or naturopathic doctor.

16. You’re working through trauma: In many cases, trauma leads to depression and anxiety. If you’ve experienced a traumatic event or relationship, it’s important to seek professional help to mitigate the emotionally painful effects.

Finally, if you’re experiencing prolonged or chronic anxiety or depression, consider working with a professional therapist or coach to dissect what your symptoms are telling you and make steps toward healing. As much as knowing this information can be helpful, making changes in each area can feel overwhelming within the paralyzing context of compromised mental health. Despite what depression might be telling you, you deserve to live a life free of unnecessary pain Be gentle with yourself on your journey and start by reaching out for help.

Megan Bruneau, M.A. RCC is a mental health therapist, writer, wellness coach, and podcast host. Through her own recovery from perfectionism-fueled depression, anxiety, and eating disorders, Megan discovered a different way of relating to herself and the world – one she now teaches her clients and readers. Megan's work has garnered upwards of 15 million views and has appeared in The Huffington Post, MindBodyGreen, Forbes, Entrepreneur, Thought Catalog, Gaia, Bustle, Psych Central, Elephant Journal, Thrillist, and more. Work with her 1:1 or read, listen, and watch more from her at meganbruneau.com.